Parkinson's Case Study - Nick Pre-Treatment Assessment
Assessment Results and Comments
|Comments on Parkinsonian Features of Gait|
over cut off score (falls risk)
|Initiates gait immediately on standing; generally more flexed posture with reduced left arm swing and slow walk; watches for turning point; tremor both hands; six step for 180° turn (falls risk). Good step length and clearance of feet except on turn.|
|Motor on motor dual task||15.20 secs (not > 10% so the dual task does not increase falls risk)||Pushes up from chair; pauses before initiating gait; passes turn point as looking up. 4 step turn|
|Cognitive on motor dual task||15.40 secs (not > 10%)||Even less arm swing; pauses before initiating gait; 5 step turn; less symmetry between steps|
|Steps forward 3m||6 steps||Confident, large steps|
|Steps backwards 3m||8 steps||Drags feet backwards – can hear the scuffing during all steps|
To work out if dual tasking is of help or increases risk of falls, work out the 10% range either side of baseline i.e. for Nick’s baseline of 14.56 seconds, the range is 13.10 to 16.02 seconds. Adding the motor and cognitive task to baseline pre-treatment was not outside the 10% baseline range, so does not increase the risk of falling with this test, but his combined transfer, walking pattern and turns take longer to complete than is deemed ‘safe’.
The TUG may not be a tool of choice to look at gait, but for example, using a tool such as the Tinneti gait scale, you would record no hesitancy of gait initiation during the baseline walk, but hesitation when a second task is added, step length and height of feet are fine until he turns; symmetry affected but path and continuity of gait pattern fine, as is foot distance, but trunk is stiffer – this would give a score between 7 – 9/ 12 depending on the addition of a second task – again, demonstrating there are components that put Nick at moderate risk of a fall in the future.
Tragus to wall test
Nick never fully extends either knees or hips during his walk (forwards or backwards) despite the good step size. Although his walk is purposeful, the stress through the anterior knee joint constantly flexed during joint loading when in stance could be a reason for his pain. As I wanted to see whether the flexion was correctable, we performed a Tragus to wall test to understand the influence of forward pull on upright stance, and therefore gait.
|Test: Tragus to wall
(Nick’s optimal is 15 cms +/- 3 cms)
|Pre-Treatment||26 cms – outside chest base||24 cms – outside chest base|
*This page forms part of the Parkinson's Disease Outcome Measures Case Study Course